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The natural history of de novo donor-specific HLA antibodies after kidney transplantation

BACKGROUND: De novo donor-specific HLA antibodies (dnDSA) are key factors in the diagnosis of antibody-mediated rejection (ABMR) and related to graft loss. METHODS: This retrospective study was designed to evaluate the natural course of dnDSA in graft function and kidney allograft survival and to as...

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Autores principales: López del Moral, Covadonga, Wu, Kaiyin, Naik, Marcel, Osmanodja, Bilgin, Akifova, Aylin, Lachmann, Nils, Stauch, Diana, Hergovits, Sabine, Choi, Mira, Bachmann, Friederike, Halleck, Fabian, Schrezenmeier, Eva, Schmidt, Danilo, Budde, Klemens
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523126/
https://www.ncbi.nlm.nih.gov/pubmed/36186822
http://dx.doi.org/10.3389/fmed.2022.943502
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author López del Moral, Covadonga
Wu, Kaiyin
Naik, Marcel
Osmanodja, Bilgin
Akifova, Aylin
Lachmann, Nils
Stauch, Diana
Hergovits, Sabine
Choi, Mira
Bachmann, Friederike
Halleck, Fabian
Schrezenmeier, Eva
Schmidt, Danilo
Budde, Klemens
author_facet López del Moral, Covadonga
Wu, Kaiyin
Naik, Marcel
Osmanodja, Bilgin
Akifova, Aylin
Lachmann, Nils
Stauch, Diana
Hergovits, Sabine
Choi, Mira
Bachmann, Friederike
Halleck, Fabian
Schrezenmeier, Eva
Schmidt, Danilo
Budde, Klemens
author_sort López del Moral, Covadonga
collection PubMed
description BACKGROUND: De novo donor-specific HLA antibodies (dnDSA) are key factors in the diagnosis of antibody-mediated rejection (ABMR) and related to graft loss. METHODS: This retrospective study was designed to evaluate the natural course of dnDSA in graft function and kidney allograft survival and to assess the impact of mean fluorescence intensity (MFI) evolution as detected by annual Luminex(®) screening. All 400 kidney transplant recipients with 731 dnDSA against the last graft (01/03/2000-31/05/2021) were included. RESULTS: During 8.3 years of follow-up, ABMR occurred in 24.8% and graft loss in 33.3% of the cases, especially in patients with class I and II dnDSA, and those with multiple dnDSA. We observed frequent changes in MFI with 5-year allograft survivals post-dnDSA of 74.0% in patients with MFI reduction ≥ 50%, 62.4% with fluctuating MFI (MFI reduction ≥ 50% and doubling), and 52.7% with doubling MFI (log-rank p < 0.001). Interestingly, dnDSA in 168 (24.3%) cases became negative at some point during follow-up, and 38/400 (9.5%) patients became stable negative, which was associated with better graft survival. Multivariable analysis revealed the importance of MFI evolution and rejection, while class and number of dnDSA were not contributors in this model. CONCLUSION: In summary, we provide an in-depth analysis of the natural course of dnDSA after kidney transplantation, first evidence for the impact of MFI evolution on graft outcomes, and describe a relevant number of patients with a stable disappearance of dnDSA, related to better allograft survival.
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spelling pubmed-95231262022-10-01 The natural history of de novo donor-specific HLA antibodies after kidney transplantation López del Moral, Covadonga Wu, Kaiyin Naik, Marcel Osmanodja, Bilgin Akifova, Aylin Lachmann, Nils Stauch, Diana Hergovits, Sabine Choi, Mira Bachmann, Friederike Halleck, Fabian Schrezenmeier, Eva Schmidt, Danilo Budde, Klemens Front Med (Lausanne) Medicine BACKGROUND: De novo donor-specific HLA antibodies (dnDSA) are key factors in the diagnosis of antibody-mediated rejection (ABMR) and related to graft loss. METHODS: This retrospective study was designed to evaluate the natural course of dnDSA in graft function and kidney allograft survival and to assess the impact of mean fluorescence intensity (MFI) evolution as detected by annual Luminex(®) screening. All 400 kidney transplant recipients with 731 dnDSA against the last graft (01/03/2000-31/05/2021) were included. RESULTS: During 8.3 years of follow-up, ABMR occurred in 24.8% and graft loss in 33.3% of the cases, especially in patients with class I and II dnDSA, and those with multiple dnDSA. We observed frequent changes in MFI with 5-year allograft survivals post-dnDSA of 74.0% in patients with MFI reduction ≥ 50%, 62.4% with fluctuating MFI (MFI reduction ≥ 50% and doubling), and 52.7% with doubling MFI (log-rank p < 0.001). Interestingly, dnDSA in 168 (24.3%) cases became negative at some point during follow-up, and 38/400 (9.5%) patients became stable negative, which was associated with better graft survival. Multivariable analysis revealed the importance of MFI evolution and rejection, while class and number of dnDSA were not contributors in this model. CONCLUSION: In summary, we provide an in-depth analysis of the natural course of dnDSA after kidney transplantation, first evidence for the impact of MFI evolution on graft outcomes, and describe a relevant number of patients with a stable disappearance of dnDSA, related to better allograft survival. Frontiers Media S.A. 2022-09-16 /pmc/articles/PMC9523126/ /pubmed/36186822 http://dx.doi.org/10.3389/fmed.2022.943502 Text en Copyright © 2022 López del Moral, Wu, Naik, Osmanodja, Akifova, Lachmann, Stauch, Hergovits, Choi, Bachmann, Halleck, Schrezenmeier, Schmidt and Budde. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
López del Moral, Covadonga
Wu, Kaiyin
Naik, Marcel
Osmanodja, Bilgin
Akifova, Aylin
Lachmann, Nils
Stauch, Diana
Hergovits, Sabine
Choi, Mira
Bachmann, Friederike
Halleck, Fabian
Schrezenmeier, Eva
Schmidt, Danilo
Budde, Klemens
The natural history of de novo donor-specific HLA antibodies after kidney transplantation
title The natural history of de novo donor-specific HLA antibodies after kidney transplantation
title_full The natural history of de novo donor-specific HLA antibodies after kidney transplantation
title_fullStr The natural history of de novo donor-specific HLA antibodies after kidney transplantation
title_full_unstemmed The natural history of de novo donor-specific HLA antibodies after kidney transplantation
title_short The natural history of de novo donor-specific HLA antibodies after kidney transplantation
title_sort natural history of de novo donor-specific hla antibodies after kidney transplantation
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9523126/
https://www.ncbi.nlm.nih.gov/pubmed/36186822
http://dx.doi.org/10.3389/fmed.2022.943502
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